Hahn Budget Phases Out Jail Doctors

Los Angeles Mayor James K. Hahn’s budget proposes phasing doctors out of the city’s three main jails and instead relying on nurses to cut spending, a move that proponents say is needed to balance the budget but that LAPD officials and others warn could endanger the health of inmates and end up costing the city more money than it saves.

Currently, 12 physicians and 24 nurses provide round-the-clock care to an average of 370 arrestees in the city’s large jails, which house inmates while they are awaiting transfer to county lockups. The proposal, backed by the city’s Personnel Department, would phase out the physicians through attrition. This year’s budget cuts one position at a savings of $138,816.

The proposal calls for prisoners to be served by 28 nurses and four part-time doctors, who would make rounds and be on call for telephone consultation. Fully implementing the proposal would take years and eventually save the city $1.4 million annually, said Tom Coultas, assistant general manager of the Personnel Department.

Deputy Mayor Matt Middlebrook, a Hahn spokesman, said prisoners who need greater medical care than the nurses can provide would be taken to a hospital--something that already happens now with doctors in the jails.

“They would receive the same level of care they currently have,” he said. “It’s more cost-efficient to have nurses on duty.”

However, Los Angeles Police Department officials and other critics of the proposal say taking doctors out of the jails could expose the city to lawsuits and take police officers off the streets.

“Any savings accrued by phasing out 24-hour physician staffing at the three Jail Division infirmaries could be wiped out by a single lawsuit resulting from inadequate care,” outgoing Police Chief Bernard C. Parks wrote in a letter to the City Council’s Budget Committee.

One union leader echoed Parks’ concern. “All this is going to do is cause delays, perhaps failure to treat arrestees in need of care, and greatly increase the liability of the city of Los Angeles,” said Cheryl Parisi, executive director of the American Federation of State, County and Municipal Employees Council 36, which represents the jail doctors.

Assistant City Atty. Mark Burton acknowledged that a prisoner could sue the city under state and federal law for failing to provide appropriate medical care.

“Potentially, there’s significant liability,” he said. “There is a duty to provide adequate medical care [while] they’re in our custody and control.”

Burton said, however, that the city has been sued on the grounds of jail physicians providing poor medical care.

In 2000, the city paid a $40,000 settlement to a prisoner who said his Van Nuys jail physician failed to give him proper medication. An active case alleges that a prisoner taken to Van Nuys jail suffered brain damage as the result of inadequate medical care, Burton said.

Parks said in his letter that nurses refer about 80% of arrestees brought to the jails to the physicians on duty. He said he worries that many of those prisoners would have to be taken to the hospital.

Each time a prisoner needs treatment that nurses can’t provide, two officers would have to ferry him to the hospital, stay with him for hours there, and then return him to jail, said Peter DiCarlo, civilian commanding officer of the LAPD’s jail division. “That pulls more officers out of street patrol.”

Parks wrote that each hospital visit would cost $186 in salary, plus more than $1,000 in transfer, maintenance and other hospital costs.

The Personnel Department’s Coultas conceded that there are matters that need to be resolved.

“We have serious issues to address with the Police Department in terms of making this proposal work,” he said.

Dr. Ellen Goudlock has worked at the jails in Van Nuys and Parker Center since 1987. Some days she sees 60 arrestees, other days she sees none.

She said the idea of having nurses phone on-call doctors for advice won’t work, because physicians are precluded by their licenses from giving medical orders for a patient they have not seen.

And registered nurses are not trained to provide the care that she offers, Goudlock said

“The nurses went to school for nursing. They did not go to school to practice medicine,” she said. “The nurses do things at the order given by the doctors. They cannot do things on their own.”